Greater Use of Vaccine for Infection Is Urged

Thursday

Nov 26, 2009 at 5:09 AM

Bacterial infections, for which there is an underused treatment, can be a common and sometimes deadly swine flu complication.

DONALD G. McNEIL Jr.

There has been a “worrisome spike” in secondary bacterial infections among Americans with swine flu, federal health officials said Wednesday, urging more people at risk to get the underused vaccine that prevents some of those infections.

Bacterial infections are a common and sometimes deadly flu complication for the elderly, said Dr. Anne Schuchat, director of immunization and respiratory disease for the Centers for Disease Control and Prevention. But in this pandemic, they are becoming more common among children and younger adults.

For example, Dr. Schuchat said, Denver, one of 10 cities where her agency monitors circulating bacterial strains, has 20 serious cases in a typical October. Last month it had 58, two-thirds in adults under age 60.

Experts believe bacteria living in the nose and throat get into lung tissue that has been inflamed by fighting the flu virus and cause pneumonia. They may then reach the blood or brain, causing even more dangerous infections. The most common sign, Dr. Schuchat said, is a sudden relapse in a flu patient who had been recovering.

Dr. Schuchat was both alerting doctors to watch for such infections and endorsing a vaccine that prevents them. The Pneumovax vaccine, which protects against 23 strains of the most common pneumonia bacteria, is routinely given to adults over 65. But any adult with asthma, emphysema, a smoking habit, diabetes, or lung, heart, kidney or liver disease should get it now, Dr. Schuchat said. Only a quarter of those younger adults have probably had it.

Meanwhile, more swine flu vaccine is becoming available every week, and 61 million doses are available now.

Officials have been monitoring reports of side effects among the tens of millions of people who have been vaccinated since the campaign began on Oct. 5, and the results are “extremely reassuring,” Dr. Schuchat said. “The patterns are pretty much exactly what we see with the seasonal flu vaccine.”

In a national database tracking bad events after vaccinations, 94 percent were classified “not serious,” mostly sore arms, she said.

Officials routinely expect a few serious, even fatal, allergic reactions when millions get flu shots, usually because of undiagnosed allergies to the eggs in which the vaccine is grown. There have been six serious allergic reactions, all successfully treated, which is “not more than we’d expect,” Dr. Schuchat said.

Eleven deaths were reported, but some were diagnosed as having other causes, like heart attacks or kidney failure in dialysis patients. One person died in a car crash immediately after leaving the clinic.

Ten cases of possible Guillain-Barré syndrome were reported. But, Dr. Schuchat noted, it is diagnosed in 80 to 160 Americans each week whether they have had shots or not.

Guillain-Barré results when the body, for unknown reasons, attacks its own nerve cells; it can cause temporary or permanent paralysis and, in rare cases when it reaches the muscles inflating the lungs, can kill. In 1976, fears that it was striking unusual numbers of people who had that year’s swine flu vaccine brought an end to the national vaccination drive. But vaccines are now better purified and people who get seasonal flu shots have no more cases than those who do not. Also, Guillain-Barré can be triggered by both flu itself and by bacteria.

Asked about a report out of Charleston, W.Va., that a local doctor had caught the swine flu twice, with both cases lab-confirmed, Dr. Schuchat said it was “not common, but not impossible.” Vaccinations do not always produce perfect immunity, she said, so it would make sense that infections sometimes do not either. (For example, people do sometimes get chicken pox twice.)